上前牙区种植相关解剖因素CBCT研究

CBCT study on the anatomical factors related to anterior dental implants

目的通过对400例成人上前牙区CBCT图像进行测量统计,了解上前牙区种植相关解剖因素,为美学区种植提供参考。方法筛选纳入400例患者CBCT图像,测量唇、腭侧不同位点的骨量并探索上前牙根和牙槽骨的位置关系。结果唇侧骨壁厚度在根尖处较厚,在唇侧牙槽嵴顶下2 mm处较薄,在根中1/2处最薄,唇侧牙槽嵴顶下2 mm和根中1/2处骨壁厚度>1 mm所占比率在中切牙至尖牙分别为37%、30%;31%、27%;56%、34%。腭侧骨壁厚度自牙槽嵴顶向根方递增,根方骨量>5 mm所占比率在中切牙至尖牙分别为94%、82%、97%。中切牙至尖牙相对于牙槽骨的位置关系分型Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别为79.5%、10.5%、1.0%、2.0%;72.0%、14.5%、3.0%、5.0%;83.0%、5.5%、0.0%、0.5%。Ⅰ亚类(根尖区唇侧骨板厚度图像精度上难以分辨)各牙位占比分别为7.0%、5.5%、11.0%。结论上前牙区唇侧嵴顶及根中处骨板厚度普遍很薄,绝大多数位点骨厚度<1 mm,根中1/2厚度最小;腭侧骨壁厚度自嵴顶向根方递增。上前牙根和牙槽骨多数属于Ⅰ类位置关系,为美学区即刻种植提供有利解剖位置,但Ⅰ亚类的位置,因唇侧骨壁菲薄并可能缺损,提示种植手术前对植骨方式的更多考量。

Objective To have a better understanding of the anatomical factors related to the anterior dental implants through measurement and analysis of CBCT images of 400 adult anterior dental regions,,so as to provide reference for implant in aesthetic.Methods CBCT images of 400 patients were selected and enrolled in this study.The bone thickness at different sites of the labial and palate were measured and the positional relationship between the root of the upper anterior teeth and the alveolar bone was explored.Results The labial bone wall thickness was thicker at the apex of the root,thinner at 2 mm below the crest of the labial alveolar side and the thinnest at 1/2 the mid-root.The percentage of bone wall thickness>the proportion of 1mm in the in central incisor teeth to cuspid teeth was 37%,30%;31%,27%;and 56%,34%,respectively.The thickness of palatal bone showed an increasing tend from the crest of alveolar to the root.The proportion of root bone mass>the proportion of 5 mm in the in central incisor teeth to cuspid teeth was 94%,82%and 97%,respectively.The position relationship of central incisor teeth,cuspid teeth and alveolar bone was classified as TypeⅠ,Ⅱ,ⅢandⅣ.TypeⅠ,Ⅱ,ⅢandⅣwere 79.5%,10.5%,1.0%,2.0%;72.0%,14.5%,3.0%,5.0%;83.0%,5.5%,0.0%,0.5%,respectively.Subtype I:(it was difficult to distinguish the thickness of the labial bone plate in the accuracy images)the proportion of each tooth position was 7.0%,5.5%,11.0%,respectively.Conclusions The thickness of bone plate at the crest of labial alveloar and the mid-root of anterior dental area is generally thin,and the thickness of alveolar bone in most sites was less than 1mm.The labial bone wall thickness in the mid-root is the minimum.The palatal bone wall thickness showed an increasing tend from the crest of alveolar to the root.The position relationship between maxillary anterior root and alveolar bone is mostly type I,which provides a favorable anatomical position for immediate implantation in the aesthetic area,but the location of subtype I,due to the thin labial bone wall and possible defect,suggesting that more consideration should be given to the way of bone grafting before implantation.